Methods and devices for vein harvesting

ABSTRACT

A vein harvesting device is disclosed. The vein harvesting device includes a handle assembly, an elongated portion extending distally from the handle assembly and defining a longitudinal axis, an end effector, and a retractor. The end effector is disposed adjacent a distal portion of the elongated portion, and includes a first jaw member and a second jaw member. At least one jaw member is movable toward the other jaw member. The retractor is disposed in mechanical cooperation with the elongated portion, and includes a shaft and a pair of legs. The retractor is movable from a non-deployed position where the shaft is aligned with the longitudinal axis, to a deployed position where the shaft is disposed at an angle with respect to the longitudinal axis.

CROSS REFERENCE TO RELATED APPLICATION

The present application claims the benefit of and priority to U.S.Provisional Application Ser. No. 62/063,492, filed on Oct. 14, 2014, theentire contents of which are incorporated herein by reference.

BACKGROUND

The present disclosure relates to methods and devices for endoscopicsurgery, in particular to methods and devices for dissecting tissue tocreate a working space for endoscopic instruments.

TECHNICAL FIELD

Numerous surgical procedures have been developed to replace veins andarteries that have become blocked by disease. As a result of agingand/or disease, veins and arteries may become blocked by plaquedeposits, stenosis, or cholesterol. In some instances, these blockagescan be treated with artherectomy, angioplasty or stent placement, andcoronary bypass surgery is not required. Coronary bypass surgery isrequired when these other methods of treatment cannot be used or havefailed to clear the blocked vein or artery. In the coronary bypasssurgery, a vein is harvested from elsewhere in the body and grafted intoplace (e.g., between the aorta and the coronary artery) beyond the pointof blockage.

The coronary bypass surgery requires a length of vein or artery for thegraft. It is preferred to use a vein taken from the patient undergoingthe bypass surgery. The patient is a ready source of suitable veins thatwill not likely be rejected by the body after transplantation andgrafting onto the aorta and coronary artery. The saphenous vein in theleg is often the best substitute for small veins or arteries such as thecoronary arteries, and it is often the preferred vein for use incoronary bypass surgery. This is because the saphenous vein is typically3 to 5 mm in diameter, about the same size as the coronary arteries.Also, the venous system of the legs is sufficiently redundant so thatafter removal of the saphenous vein, other veins that remain in the legare adequate to provide adequate blood flow. The cephalic vein in thearm is an alternative that is sometimes used.

In a typical operation previously required to harvest the saphenousvein, the surgeon cut into the leg to allow access to the saphenous veinand cut the vein from the leg. To expose the vein, the surgeon makes aseries of incisions from the groin to the knee or the ankle leaving oneor more skin bridges along the line of the incisions. (Some surgeonsmake one continuous incision from the groin to the knee or ankle).Handling of the vein must be kept to a minimum, but the vein must beremoved from connective tissue, which requires some force. Afterexposing the vein, the surgeon grasps it with his fingers whilestripping off the surrounding tissues with dissecting scissors or otherscraping instruments. The surgeon uses his fingers and blunt dissectiontools to pull and lift (or mobilize) the vein from the surroundingtissue. The vein is mobilized or pulled as far as possible through eachincision. To reach under the skin bridges, the surgeon lifts the skinwith retractors and digs the vein free. While stripping the vein, thesurgeon will encounter the various tributary veins that feed into thesaphenous vein. These tributaries must be ligated and divided. To divideand ligate tributaries that lie under the skin bridges, the surgeon mayneed to cut one end of the saphenous vein and pull it under the skinbridge to gently pull the vein out from under the skin bridge until thetributary is sufficiently exposed so that it may be ligated and divided.When the vein has been completely mobilized, the surgeon cuts theproximal and distal ends of the vein and removes the vein from the leg.After removal, the vein is prepared for implantation into the graftsite, and the long incisions made in the leg are stitched closed.

The procedure described above can also be used to harvest veins for afemoral popliteal bypass, in which an occluded femoral artery isbypassed from above the occlusion to the popliteal artery above or belowthe knee. The procedure can also be used to harvest veins for therevascularization of the superior mesenteric artery which supplies bloodto the abdominal cavity and intestines. In this case, the harvested veinis inserted between the aorta to the distal and patent (unblocked)section of the mesenteric artery. For bypass grafts of the lowerpopliteal branches in the calf, the procedure can be used to harvest theumbilical vein. The harvested vein can also be used for a vein loop inthe arm (for dialysis) between the cephalic vein and brachial artery.The procedures may be used also to harvest veins for femoral-tibial,femora-peroneal, aorto-femoral, and iliac-femoral bypass operations andany other bypass operation.

As can be seen from the description of the harvesting operation, theharvesting operation is very traumatic in its own right. In the case ofcoronary artery bypass, this operation is carried out immediately beforethe open chest operation required to graft the harvested vein onto thecoronary arteries. The vein harvesting operation is often the mosttroublesome part of the operation. The long incisions created in the legcan be slow to heal and very painful. Complications resulting from thevein harvesting operation can also hinder the patient's recovery fromthe entire operation.

Additionally, during the harvesting of the saphenous vein, it is oftendesirable to leave as much of the pedicle (i.e., between about 4 mm andabout 5 mm of perivascular fat surrounding the vein) preserved aspossible. The preservation of the pedicle helps the saphenous veinremain uninjured during surgery, and also helps the long-term patencyand viability of the saphenous vein. For instance, following thesurgery, the pedicle acts as a natural sheath to help prevent thesaphenous vein from getting unnaturally distended due to higher arterialpressures.

The method of vein harvesting presented herein is accomplished withendoscopic procedures while preserving much of the pedicle. This allowsthe vein to be harvested in an operation that requires only a few smallincisions, and increases the patency of the vein. Endoscopic surgicaltechniques for operations such as gall bladder removal and hernia repairare now common. The surgeon performing the operation makes a few smallincisions and inserts long tools, including forceps, scissors, andstaplers into the incision and deep into the body. Viewing the toolsthrough an endoscope, or a video display from an endoscope, the surgeoncan perform all the cutting and suturing operations necessary for a widevariety of operations. The procedures are also referred to as endoscopicsurgery, laparoscopic surgery, minimally invasive surgery, orvideo-assisted surgery. References to endoscopic surgery and endoscopesbelow is intended to encompass all of these fields, and all operationsdescribed below with reference to endoscopes can also be accomplishedwith laparoscopes, gastroscopes, and any other imaging devices which maybe conveniently used.

Minimally invasive procedures for vein removal have been proposed.Knighton, Endoscope and Method for Vein Removal, U.S. Pat. No. 5,373,840shows a method of cutting the saphenous vein at one end, and graspingthe vein with graspers or forceps, then sliding a ring over the veinwhile securing the vein at the same time. Knighton uses a dissectingtool with an annular cutting ring, and requires that the saphenous veinbe overrun or progressively surrounded with the dissecting tool and theendoscope, so that after the endoscope has been inserted as far as itwill go, the entire dissected portion of the vein has been pulled in thelumen of the endoscope. As shown in FIGS. 1 and 10 of Knighton, themethod requires deployment of the forceps inside the annular dissectionloop, and it requires deployment of the loop and graspers inside theendoscope lumen. The blood vessel must be cut and grasped by the forcepsbefore it can be dissected by the dissecting ring.

SUMMARY

The present disclosure relates to a vein harvesting device, comprising ahandle assembly, an elongated portion extending distally from the handleassembly and defining a longitudinal axis, an end effector, and aretractor. The end effector is disposed adjacent a distal portion of theelongated portion, and includes a first jaw member and a second jawmember. At least one jaw member is movable toward the other jaw member.The retractor is disposed in mechanical cooperation with the elongatedportion, and includes a shaft and a pair of legs. The retractor ismovable from a non-deployed position where the shaft is aligned with thelongitudinal axis, to a deployed position where the shaft is disposed atan angle with respect to the longitudinal axis.

In disclosed aspects, the legs of the retractor are made from a shapememory material. Here, it is disclosed that a distance between the legsof the retractor in the non-deployed position is smaller than thedistance between the legs of the retractor in the deployed position.

In disclosed aspects, the legs include an inner surface configured forcontacting tissue, and wherein the inner surface of the legs includes anon-traumatic material disposed thereon.

In disclosed aspects, the retractor is rotatable about the longitudinalaxis.

In disclosed aspects, the retractor is rotatable about the longitudinalaxis independently of the end effector.

In disclosed aspects, the end effector is configured to seal tissue.

The present disclosure also relates to a method of endoscopicallyharvesting the saphenous vein and surrounding pedicle. The methodcomprises using a vein harvesting device including a handle assembly, anelongated portion extending distally from the handle assembly anddefining a longitudinal axis, an end effector, and a retractor. The endeffector is disposed adjacent a distal portion of the at least oneelongated portion, and includes a first jaw member and a second jawmember. At least one jaw member is movable toward the other jaw member.The retractor is disposed in mechanical cooperation with the elongatedportion, and includes a shaft and a pair of legs. The method alsoincludes endoscopically inserting at least a portion of the veinharvesting device adjacent the saphenous vein of a patient, sealingand/or cutting tissue with the end effector of the vein harvestingdevice, deploying the retractor of the vein harvesting device from anon-deployed position where the shaft is aligned with the longitudinalaxis, to a deployed position where the shaft is disposed at an anglewith respect to the longitudinal axis, positioning the legs of theretractor into contact with at least one the saphenous vein and pedicleto be removed, and removing at least a portion of the saphenous vein andpedicle from the patient.

In disclosed aspects of the method, sealing and/or cutting tissue withthe end effector of the vein harvesting device includes sealing and/orcutting tissue surrounding the pedicle.

In disclosed aspects of the method, the method also includes rotatingthe retractor about the longitudinal axis.

In disclosed aspects of the method, the method also includes rotatingthe retractor about the longitudinal axis independently of the endeffector.

BRIEF DESCRIPTION OF THE DRAWINGS

Various embodiments of the surgical devices are described herein withreference to the drawings wherein:

FIG. 1 illustrates a vein harvesting device in accordance withembodiments of the present disclosure;

FIG. 2 is a perspective view of a distal end of the vein harvestingdevice of FIG. 1;

FIGS. 3 and 4 are perspective views of a distal end of the veinharvesting device of FIGS. 1 and 2 shown in engagement with a vein;

FIG. 5A illustrates the vein harvesting device of FIGS. 1-4 with itsdistal end within a patient;

FIG. 5B illustrates the distal end of the vein harvesting device ofFIGS. 1-5A within the patient;

FIG. 6 is a schematic side view of a distal end of a vein harvestingdevice according with embodiments of the present disclosure, and whichincludes an ultrasound probe;

FIGS. 7A and 7B are schematic side and front views, respectively, of thevein harvesting device of FIG. 6 located adjacent a saphenous vein andadjacent pedicle;

FIGS. 8A and 8B are schematic side and front views, respectively, of avein harvesting device located adjacent the saphenous vein and locatedwithin the pedicle;

FIG. 9A illustrates a vein harvesting device with its distal end withina patient in accordance with embodiments of the present disclosure;

FIG. 9B illustrates the distal portion of the vein harvesting device ofFIG. 9A including a retractor shown in a non-deployed position and

FIG. 9C illustrates the distal portion of the vein harvesting device ofFIGS. 9A and 9B showing the retractor in a deployed position.

DETAILED DESCRIPTION

Embodiments of the presently disclosed vein harvesting device aredescribed in detail with reference to the drawings, in which likereference numerals designate identical or corresponding elements in eachof the several views. As used herein the term “distal” refers to thatportion of the vein harvesting device that is farther from the user,while the term “proximal” refers to that portion of the vein harvestingdevice that is closer to the user.

The saphenous vein has a number of tributary veins that carry venousblood into the vein. These tributaries are typically tied off and/or cutoff of the saphenous vein before the saphenous vein can be removed. Inmedical terms, these tributaries must be ligated and divided. When atributary or side branch is encountered, the surgeon can use endoscopicand laparoscopic tools, for example, to close the tributaries and cutthem from the saphenous vein. The tributaries can be separated from thevein after the entire vein is stripped, or the surgeon may choose toseparate them as they are encountered.

Referring initially to FIGS. 1-5B, one embodiment of a vein harvestingdevice 10 is shown for use with various surgical procedures andgenerally includes a handle assembly 100, a first elongated (e.g.,endoscopic) portion 200 a extending distally from handle assembly 100and defining a first longitudinal axis “A-A,” and a second elongated(e.g., endoscopic) portion 200 b extending distally from handle assembly100 and defining a second longitudinal axis “B-B.” The first endeffector 300 a is disposed adjacent a distal portion of first elongatedportion 200 a, the second end effector 300 b is disposed adjacent adistal portion of second elongated portion 200 b, and a tip 400 isdisposed adjacent first and second end effectors 300 a, 300 b. Veinharvesting device 10 is configured to efficiently remove at leastportions of a target vein “V” (e.g., the saphenous vein) while alsoremoving pedicle (i.e., the facial layer surrounding the vein “V”) tohelp the viability of the vein “V” after transplantation thereof.Additionally, vein harvesting device 10 is configured to be usedendoscopically, e.g., to reduce the chances of infection.

Tip or blunt dissection tip 400 extends distally of end effectors 300 a,300 b and is configured to dissect (e.g., bluntly dissect) or scrapetissue away from the target vein “V” as tip 400 is advanced distally,e.g., while maintaining at least a portion of the pedicle. As shown inFIGS. 1-5B, it is envisioned that tip 400 is scoop-like in shape,defining a hollow cavity 404 therein. The scoop-like shape of tip 400 isconfigured to scrape tissue away from the target vein “V” and away fromend effectors 300 a, 300 b disposed at least partially within cavity404. Additionally, it is envisioned that at least a portion of the tip400 (e.g., the entirety of tip 400) is transparent or translucent. Ascan be appreciated, the transparency or translucency of tip 400facilitates the viewing of target tissue and the vein “V” by a surgeonor an endoscope, and allows light to shine through tip 400 to illuminatethe target tissue and the vein “V.”

Handle assembly 100 is configured to control actuation of end effectors300 a, 300 b. Actuation of end effectors 300 a, 300 b includes openingand approximating of at least a first jaw member 310 a, 310 b withrespect to a second jaw member 320 a, 320 b, cutting tissue held betweenfirst member 310 a, 310 b and respective second jaw member 320 a, 320 b,and sealing/fusing tissue held between the first member 310 a, 310 b andrespective second jaw member 320 a, 320 b by applying energy thereto.Details of a surgical instrument including a handle assembly forcontrolling actuation of a single end effector can be found in U.S.patent application Ser. Nos. 10/179,863 and 10/116,944, the entirecontents of which being incorporated by reference. It is envisioned thathandle assembly 100 of the present disclosure can control actuation ofend effectors 300 a, 300 b together, or individually, e.g., via athree-way rocker switch (not explicitly shown). The dual end effectors300 a, 300 b are configured to dissect tissue (e.g., side branches “SB”of the saphenous vein) away from the pedicle along two dissection planes(i.e., each dissection plane being defined by a single end effector 300a, 300 b). As can be appreciated, the dissection along two planes mayresult in a faster procedure with respect to dissection along a singleplane using a single end effector.

It is further disclosed that first jaw members 310 a, 310 b arepivotable and that second jaw members 320 a, 320 b are fixed. Here, itis disclosed that second jaw members 320 a, 320 b are fixed in a plane“T,” defined by a lower surface 402 of tip (see FIG. 3), and that firstjaw members 310 a, 310 b are pivotable. In such embodiments,longitudinal advancement of end effectors 300 a, 300 b and tip 400within tissue is facilitated; otherwise, the lower or second jaw members320 a, 320 b may protrude beyond plane “T” and impede longitudinaladvancement within tissue. It is further envisioned that first jawmembers 310 a, 310 b may be fixed and that second jaw members 320 a, 320b are pivotable.

Additionally, and as shown in the embodiment illustrated in FIGS. 3 and4, disclosed embodiments of vein harvesting device 10 include a singleelongated portion 200 having first and second end effectors 300 a, 300 bextending distally therefrom.

End effectors 300 a, 300 b and tip 400 are rotatable about axes “A-A”and “B-B,” respectively, with respect to endoscopic portions 200 a and200 b (or single endoscopic portion 200) and/or with respect to handleassembly 100. Endoscopic portions 200 a and 200 b (or single endoscopicportion 200) are rotatable about axes “A-A” and “B-B,” with respect tohandle assembly 100. Accordingly, end effectors 300 a, 300 b can berotated within tissue to access all of the tissue/side branches “SB”surrounding the vein “V” without needing to remove end effectors 300 a,300 b from within the patient.

It is further disclosed that the distance “D” between end effectors 300a, 300 b (i.e., the distance perpendicular to axes “A-A” and “B-B”) isconfigured to be larger than the width of the patient's target vein “V”(e.g., saphenous vein). Moreover, it is disclosed that distance “D” isthe width of the vein “V” plus about 2 mm to 3 mm of buffer space oneach lateral side of the vein “V.” That is, if a patient's vein “V” is 6mm, it is envisioned that the distance “D” is between about 10 mm andabout 12 mm (i.e., 6 mm+2 mm (first lateral side)+2 mm (second lateralside)=10 mm; 6 mm+3 mm (first lateral side)+3 mm (second lateralside)=12 mm). It is further envisioned that a surgeon can choose betweenvarious vein harvesting devices 10, which include a different distance“D”, based on the actual size of a particular patient's target vein “V.”Alternatively, the distance “D” may be variable using one or more dials,gears, spacers, levers, etc. associated with an actuator (not shown) toaccomplish this purpose.

Embodiments of vein harvesting device 10 of the present disclosure alsoinclude an endoscope disposed between elongated portions 200 a, 200 b.It is envisioned that the distal end of the endoscope is locatedproximally of a distal-most end 406 of tip 400 and/or proximally of atleast a majority of end effectors 300 a, 300 b. As noted above, tip 400is transparent or translucent to allow the endoscope to view thetissue/vein “V” disposed distally of tip 400.

It is further envisioned that vein harvesting device 10 includes ahollow cavity between elongated portions 200 a, 200 b (or beneath singleelongated portion 200). The hollow cavity extends along at least aportion of the length of elongated portions 200 a, 200 b and isconfigured to releasably house the patient's vein “V” during thesurgical procedure. That is, a surgeon may thread the vein “V” under aband 500, through a distal opening of the hollow cavity, through thehollow cavity, and/or out a proximal opening of the hollow cavity. Theuse of such a hollow cavity may help the surgeon isolate the vein “V” tohelp ensure the separated portion of vein “V” does not interfere withthe portions of the vein “V” that have yet to be separated from thesurrounding tissue.

Referring now to FIGS. 2 and 5B, vein harvesting device 10 is shownhaving band 500 extending between proximal portions of end effectors 300a and 300 b. In FIG. 5A, the incision “I” is shown enlarged for clarity.In FIG. 5B, the operating space “OS” is shown enlarged for clarity. Band500 (e.g., a non-traumatic, flexible silastic band) is configured tohold, maintain or retract the target vein “V” (e.g., including pedicle)of a patient “P” away from the distal end of vein harvesting device 10so as not to interfere with an end effector 300 or end effectors 300 a,300 b that may be accessing tissue. It is further disclosed that atleast one lateral side of band 500 is removably coupled to the adjacentend effector 300 a, 300 b. In such embodiments, the surgeon may removeone of the lateral ends of band 500 from end effector 300 a, 300 b(e.g., via a separate instrument), wrap that portion of band 500 aroundthe target vein “V,” and then move the removed lateral end of band 500back into engagement with end effector 300 a, 300 b, such that the vein“V” is secured between end effectors 300 and 300 b, as shown in FIG. 5B.It is envisioned that the removable coupling of a lateral end of band500 is accomplished by threading/unthread/tying/untying that portion ofband 500 through/to an aperture and/or hook on end effector 300 a and/or300 b.

It is further envisioned that band 500 can be deployed and/or retractedwith the use of a control (e.g., switch) on handle assembly 100. Band500 may initially lie parallel with either first elongated portion 200 aor second elongated portion 200 b. Here, band 500 can be deployed, e.g.,by a switch, to hold, maintain or retract the target vein “V” andsurrounding perivascular fat (e.g., pedicle “P”) by orienting band 500in an axis perpendicular to the “A” and “B” axes. It is envisioned thatband 500 can be reset back into its original position by using the sameswitch.

It is also disclosed that band 500 (e.g., disposed in a differentsuitable location) holds the vein “V” either between elongated portions200 a and 200 b or adjacent a single elongated portion 200 a or 200 b.It is also disclosed that band 500 is used with vein harvesting device10 having a single elongated portion 200.

During vein harvesting procedures when a surgeon does not have access tothe disclosed vein harvesting device 10 or band 500, the surgeon ofteneither uses his or her finger or hand to hold back the vein “V,” or thesurgeon uses a separate instrument including a hook, for example.However, during vein harvesting inclusive of pedicle harvesting, asdescribed herein, the size and weight of the vein/pedicle (as comparedto a skeletonized vein without pedicle) impede the use of a finger, handor hook to hold back the vein/pedicle. Accordingly, band 500 of thepresent disclosure is especially useful during harvesting of the veinand pedicle.

With reference to FIGS. 6-8B, another embodiment of vein harvestingdevice 10 is shown according to embodiments of the present disclosure.Here, vein harvesting device 10 includes an ultrasound probe 600. In theillustrated embodiments, ultrasound probe 600 is disposed adjacent adistal end of vein harvesting device 10 (e.g., on or near end effector300, or near tip 400 (not illustrated in FIGS. 6-8B for clarity), etc.).The inclusion of ultrasound probe 600 enables a surgeon to determine theexact location of the particular portion of vein harvesting device 10with respect to the target vein “V.” Traditional endoscopic veinharvesting systems rely on direct visualization of the skeletonized veinby means of an endoscopic camera, for example. However, relying on anendoscopic camera to harvest the vein inclusive of the pedicle isdifficult because the vein “V” is often hidden inside the fascia.

With particular reference to FIGS. 7A and 7B, schematic side and frontviews, respectively, show vein harvesting device 10 adjacent a saphenousvein “V” and adjacent pedicle “P,” which radially surrounds the vein“V.” Here, when a surgeon is attempting to remove pedicle “P” along withthe vein “V,” the use of ultrasound probe 600 facilitates this removalby helping the surgeon determine the precise location of the distal end,for instance, of vein harvesting device 10 with respect to the vein “V.”

With particular reference to FIGS. 8A and 8B, schematic side and frontviews, respectively, show vein harvesting device 10 adjacent a saphenousvein “V” and located within pedicle “P.” Here, when a surgeon isattempting to remove the vein “V” and not the pedicle “P” (i.e.,skeletonized vein removal), it is easier for the surgeon directly viewthe skeletonized vein with an endoscopic camera, for instance, since thevein “V” is has been separated from the surrounding fascia or pedicle.

The present disclosure also includes methods of performing veinharvesting operations using vein harvesting device 10 discussed herein,and methods of manufacturing vein harvesting device 10 discussed herein.

Methods and devices presented herein take advantage of laparoscopicprocedures to lessen the trauma of vein harvesting operations. Insteadof making an incision along or over the entire length, or essentiallythe entire length of the vein “V” to be harvested, the procedure may beconducted with only a few small incisions or a single incision. All thatis needed is a working space large enough to allow the surgeon to usevein harvesting device 10 and view the operation through a laparoscope,for example. In disclosed embodiments of the method, the surgeon createsa working space under the skin and over the saphenous vein usinglaparoscopic techniques. The surgeon makes one or several smallincisions to expose the saphenous vein. These incisions are referred toas cut-downs. A distal incision near the knee and/or a proximal incisionat the groin are contemplated. If the entire length of the saphenousvein is to be harvested, an additional incision can be made close to theankle. The saphenous vein can be seen through the cut-downs. The use ofthree or four incisions used to harvest the entire saphenous vein aremerely a matter of convenience, and those particularly skilled inlaparoscopic procedures may require fewer incisions, and also more smallincisions may be desired.

After the incision(s), the surgeon inserts vein harvesting device 10into one incision and pushes it along the saphenous vein “V” towards theother incision. The tunneling creates a channel running along thesaphenous vein “V.” The channel may be expanded by insertion of aballoon (not shown), which can be inflated to expand or propagate thetunnel further along the saphenous vein

A balloon (not shown) may packed inside vein harvesting device 10. Theballoon is a non-elastomeric balloon or bladder and may be deployedthrough a balloon trocar extending along at least a portion of thelength of vein harvesting device 10. It is disclosed that when used fortunneling along the saphenous vein “V,” the balloon is approximately 60centimeters long, and the balloon trocar may be between about 10-20centimeters long. The balloon can be expanded by injecting liquid or gasinto the balloon through an inflation port. Sterile saline solution isan example of an inflation medium for medical applications. Alternately,air, CO₂, or even foam or other substances may be injected to causeinflation. Further details of the balloon and its use for harvestingveins are disclosed in U.S. patent application Ser. No. 12/550,462, theentire contents of which being incorporated by reference herein.

With reference to FIGS. 9A-9C, a vein harvesting device according toembodiments of the present disclosure is shown, and is referenced bynumeral 1000. Vein harvesting device 1000 is configured to assist in theendoscopic removal of a patient's vein “V” (e.g., the saphenous vein)and surrounding pedicle “P.” For clarity, the incision “I” in FIG. 9A,and the operating space “OS” in FIGS. 9B and 9C are shown enlarged.

Vein harvesting device 1000 includes a handle assembly 1100, anelongated portion 1200 extending distally from handle assembly 1100, anend effector 1300 disposed adjacent a distal end of elongated portion1200, and a deployable retractor 1400 disposed in mechanical cooperationwith elongated portion or endoscopic portion 1200. Handle assembly 1100is configured to control actuation of end effector 1300 (e.g., pivotingat least one jaw member with respect to the other, and cutting andsealing tissue disposed between the jaw members). Details of a surgicalinstrument including a handle assembly for controlling actuation of anend effector can be found in U.S. patent application Ser. Nos.10/179,863 and 10/116,944, the entire contents of which have beenincorporated by reference herein.

Additionally, handle assembly 1100 is configured to control deploymentof retractor 1400 between a first, non-deployed position where a shaft1410 is aligned with a longitudinal axis “A1-A1” defined by elongatedportion 1200 (FIG. 9B), to a deployed position where shaft 1410 isdisposed at an angle (e.g., a right angle) with respect to thelongitudinal axis “A1-A1” (FIG. 9C). Any suitable controls may beincluded (e.g., on handle assembly 1100) to control deployment ofretractor 1400, such as a rotatable knob, a switch, a pivotable handle,etc.

In use, when retractor 1400 is deployed (FIG. 9C), retractor 1400 isused to keep portions of the vein “V” (e.g., the saphenous vein) andpedicle “P” away from end effector 1300. For instance, retractor 1400 isused to keep the portions of the vein “V” and pedicle “P” that havealready been separated from surrounding tissue/side branches “SB” awayfrom end effector 1300. As can be appreciated, keeping portions of thevein “V” and pedicle “P” away from end effector 1300 helps protect theseportions of the vein “V” and pedicle “P” from inadvertent contact withthe jaw members, and helps facilitate the sealing and cutting ofadditional tissue/side branches “SB.”

Retractor 1400 includes the shaft 1410 and a pair of legs 1420, whichform a U-like shape. Legs 1420 extend from shaft 1410 and are sized tohold portions of the vein “V” and pedicle “P” therebetween. As such, itis envisioned that the distance “DL” between legs 1420 is between about10 mm and about 15 mm, however the distance “DL” between legs 1420 maybe larger or smaller.

Additionally, since it is often desirable in endoscopic surgery to haveelongated portion 1200 with a diameter of less than 10 mm, legs 1420 ofretractor 1400 may be formed from a shape memory material. Here, whenretractor 1400 is in its non-deployed position (FIG. 9B), the distance“DLN” between legs 1420 is equal to or less than the diameter ofelongated portion 1200. In disclosed embodiments, when retractor 1400moves toward its deployed position (FIG. 9C), legs 1420 spring open toincrease the distance “DL” therebetween.

Additionally, the retractor 1400 may be at least partially disposedwithin a recess of elongated portion 1200 when retractor 1400 is in itsnon-deployed position, such that the profile of elongated portion 1200is substantially unchanged by the inclusion of retractor 1400. That is,in such embodiments, retractor 1400 would not increase the overalldiameter or profile of elongated portion 1200 (e.g., endoscopicportion), and thus would not hinder the endoscopic use of veinharvesting device 1000.

It is further disclosed that at least portions of retractor 1400 includea non-traumatic tissue-contacting surface. For example, at least aninner surface 1422 of legs 1420 may include a non-traumatic materialdisposed thereon to help prevent damage to the vein “V” or pedicle “P.”

Additionally, in disclosed embodiments, retractor 1400 is rotatableabout longitudinal axis “A-A,” defined by elongated portion. Theretractor 1400 may be rotatable about longitudinal axis “A-A”independently of rotation of end effector 1300, which may also berotatable about longitudinal axis “A-A.” Rotation of retractor 1400 maybe accomplished by the rotation of a knob 1430 located in mechanicalcooperation with handle assembly 1100. Knob 1430 may be mechanicallylinked to the portion of shaft 1410 that extends from elongated portion1200.

The various embodiments disclosed herein may also be configured to workwith robotic surgical systems and what is commonly referred to as“Telesurgery.” Such systems employ various robotic elements to assistthe surgeon in the operating theatre and allow remote operation (orpartial remote operation) of surgical instrumentation. Various roboticarms, gears, cams, pulleys, electric and mechanical motors, etc. may beemployed for this purpose and may be designed with a robotic surgicalsystem to assist the surgeon during the course of an operation ortreatment. Such robotic systems may include remotely steerable systems,automatically flexible surgical systems, remotely flexible surgicalsystems, remotely articulating surgical systems, wireless surgicalsystems, modular or selectively configurable remotely operated surgicalsystems, etc.

The robotic surgical systems may be employed with one or more consolesthat are next to the operating theater or located in a remote location.In this instance, one team of surgeons or nurses may prepare the patientfor surgery and configure the robotic surgical system with one or moreof the instruments disclosed herein, while another surgeon (or group ofsurgeons) remotely control the instruments via the robotic surgicalsystem. As can be appreciated, a highly skilled surgeon may performmultiple operations in multiple locations without leaving his/her remoteconsole which can be both economically advantageous and a benefit to thepatient or a series of patients.

The robotic arms of the surgical system are typically coupled to a pairof master handles by a controller. The handles can be moved by thesurgeon to produce a corresponding movement of the working ends of anytype of surgical instrument (e.g., end effectors, graspers, knifes,scissors, etc.) which may complement the use of one or more of theembodiments described herein. The movement of the master handles may bescaled so that the working ends have a corresponding movement that isdifferent (smaller or larger) than the movement performed by theoperating hands of the surgeon. The scale factor or gearing ratio may beadjustable so that the operator can control the resolution of theworking ends of the surgical instrument(s).

The master handles may include various sensors to provide feedback tothe surgeon relating to various tissue parameters or conditions, e.g.,tissue resistance due to manipulation, cutting or otherwise treating,pressure by the instrument onto the tissue, tissue temperature, tissueimpedance, etc. As can be appreciated, such sensors provide the surgeonwith enhanced tactile feedback simulating actual operating conditions.The master handles may also include a variety of different actuators fordelicate tissue manipulation or treatment further enhancing thesurgeon's ability to mimic actual operating conditions.

While several embodiments of the disclosure have been shown in thedrawings, it is not intended that the disclosure be limited thereto, asit is intended that the disclosure be as broad in scope as the art willallow and that the specification be read likewise. Therefore, the abovedescription should not be construed as limiting, but merely asexemplifications of various embodiments. Those skilled in the art willenvision other modifications within the scope and spirit of the claimsappended hereto.

What is claimed is:
 1. A vein harvesting device, comprising: a handleassembly; an elongated portion extending distally from the handleassembly and defining a longitudinal axis; an end effector disposedadjacent a distal portion of the elongated portion, the end effectorincluding a first jaw member and a second jaw member, at least one jawmember movable toward the other jaw member; and a retractor disposed inmechanical cooperation with the elongated portion, the retractorincluding a shaft and a pair of legs, the retractor movable from anon-deployed position where the shaft is aligned with the longitudinalaxis, to a deployed position where the shaft is disposed at an anglewith respect to the longitudinal axis.
 2. The vein harvesting device ofclaim 1, wherein the legs of the retractor are made from a shape memorymaterial.
 3. The vein harvesting device of claim 2, wherein a distancebetween the legs of the retractor in the non-deployed position issmaller than the distance between the legs of the retractor in thedeployed position.
 4. The vein harvesting device of claim 1, wherein thelegs include an inner surface configured for contacting tissue, andwherein the inner surface of the legs includes a non-traumatic materialdisposed thereon.
 5. The vein harvesting device of claim 1, wherein theretractor is rotatable about the longitudinal axis.
 6. The veinharvesting device of claim 1, wherein the retractor is rotatable aboutthe longitudinal axis independently of the end effector.
 7. The veinharvesting device of claim 1, wherein the end effector is configured toseal tissue.
 8. A method of endoscopically harvesting the saphenous veinand surrounding pedicle, the method comprising: using a vein harvestingdevice including: a handle assembly; an elongated portion extendingdistally from the handle assembly and defining a longitudinal axis; anend effector disposed adjacent a distal portion of the elongatedportion, the end effector including a first jaw member and a second jawmember, at least one jaw member movable toward the other jaw member; anda retractor disposed in mechanical cooperation with the elongatedportion, the retractor including a shaft and a pair of legs;endoscopically inserting at least a portion of the vein harvestingdevice adjacent the saphenous vein of a patient; at least one of sealingand cutting tissue with the end effector of the vein harvesting device;deploying the retractor of the vein harvesting device from anon-deployed position where the shaft is aligned with the longitudinalaxis, to a deployed position where the shaft is disposed at an anglewith respect to the longitudinal axis; positioning the legs of theretractor into contact with at least one the saphenous vein and pedicleto be removed; and removing at least a portion of the saphenous vein andpedicle from the patient.
 9. The method of claim 8, wherein the at leastone of sealing and cutting tissue with the end effector of the veinharvesting device includes cutting tissue surrounding the pedicle. 10.The method of claim 9, wherein the at least one of sealing and cuttingtissue with the end effector of the vein harvesting device includessealing tissue surrounding the pedicle.
 11. The method of claim 8,further comprising rotating the retractor about the longitudinal axis.12. The method of claim 8, further comprising rotating the retractorabout the longitudinal axis independently of the end effector.